Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia最新文献

{"title":"Progression of valve heart disease in a cohort of patients undergoing renal replacement therapy.","authors":"Maria Eduarda Cavalcanti Tompson, José Arthur Viana de Oliveira Pimentel, Manuella de Amorim Silva, Marcelo Antônio Oliveira Santos-Veloso, Andrea Bezerra de Melo da Silveira Lordsleem, Sandro Gonçalves de Lima","doi":"10.1590/2175-8239-JBN-2023-0036en","DOIUrl":"10.1590/2175-8239-JBN-2023-0036en","url":null,"abstract":"<p><strong>Introduction: </strong>Cardiovascular disease is an important cause of death among patients with chronic kidney disease (CKD). Valve calcification is a predictor of cardiovascular mortality and coronary artery disease.</p><p><strong>Objective: </strong>To assess heart valve disease frequency, associated factors, and progression in CKD patients.</p><p><strong>Methods: </strong>We conducted a retrospective study on 291 CKD patients at Hospital das Clínicas de Pernambuco. Inclusion criteria were age ≥ 18 with CKD and valve disease, while those on conservative management or with missing data were excluded. Clinical and laboratory variables were compared, and patients were categorized by dialysis duration (<5 years; 5-10 years; >10 years). Statistical tests, including chi-square, Fisher's exact, ANOVA, and Kruskal-Wallis, were employed as needed. Simple and multivariate binary regression models were used to analyze valve disease associations with dialysis duration. Significance was defined as p < 0.05.</p><p><strong>Results: </strong>Mitral valve disease was present in 82.5% (240) of patients, followed by aortic valve disease (65.6%; 86). Over time, 106 (36.4%) patients developed valve disease. No significant association was found between aortic, pulmonary, mitral, or tricuspid valve disease and dialysis duration. Secondary hyperparathyroidism was the sole statistically significant factor for mitral valve disease in the regression model (OR 2.59 [95% CI: 1.09-6.18]; p = 0.031).</p><p><strong>Conclusion: </strong>CKD patients on renal replacement therapy exhibit a high frequency of valve disease, particularly mitral and aortic valve disease. However, no link was established between dialysis duration and valve disease occurrence or progression.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230036"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210540/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89718336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Renal osteodystrophy and clinical outcomes: a prospective cohort study.","authors":"Cinthia Esbrile Moraes Carbonara, Joaquim Barreto, Noemi Angelica Vieira Roza, KélciaRosana da Silva Quadros, Luciene Machado Dos Reis, Aluízio Barbosa de Carvalho, Andrei C Sposito, Vanda Jorgetti, Rodrigo Bueno de Oliveira","doi":"10.1590/2175-8239-JBN-2023-0119en","DOIUrl":"10.1590/2175-8239-JBN-2023-0119en","url":null,"abstract":"<p><strong>Introduction: </strong>Renal osteodystrophy (ROD) refers to a group of bone morphological patterns that derive from distinct pathophysiological mechanisms. Whether the ROD subtypes influence long-term outcomes is unknown. Our objective was to explore the relationship between ROD and clinical outcomes.</p><p><strong>Methods: </strong>This study is a subanalysis of the Brazilian Registry of Bone Biopsies (REBRABO). Samples from individual patients were classified as having osteitis fibrosa (OF), mixed uremic osteodystrophy (MUO), adynamic bone disease (ABD), osteomalacia (OM), normal/minor alterations, and according to turnover/mineralization/volume (TMV) system. Patients were followed for 3.4 yrs. Clinical outcomes were: bone fractures, hospitalization, major adverse cardiovascular events (MACE), and death.</p><p><strong>Results: </strong>We enrolled 275 participants, of which 248 (90%) were on dialysis. At follow-up, 28 bone fractures, 97 hospitalizations, 44 MACE, and 70 deaths were recorded. ROD subtypes were not related to outcomes.</p><p><strong>Conclusion: </strong>The incidence of clinical outcomes did not differ between the types of ROD.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230119"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210535/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72014268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A plain abdominal x-ray may direct the diagnosis of primary hyperoxaluria.","authors":"Maria Helena Vaisbich, Diane Xavier de Ávila, Romulo Cézar Pizzolatti","doi":"10.1590/2175-8239-JBN-2023-0032en","DOIUrl":"10.1590/2175-8239-JBN-2023-0032en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230032"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parathyroidectomy: still the best choice for the management of severe secondary hyperparathyroidism.","authors":"Luiz Guilherme Fernandes Ramos, Daniela Del Pilar Via Reque Cortes, Luciene Machado Dos Reis, Fabio Luiz de Menezes Montenegro, Sérgio Samir Arap, Marília D'Elboux Guimarães Brescia, Melani Ribeiro Custódio, Vanda Jorgetti, Rosilene Motta Elias, Rosa Maria Affonso Moysés","doi":"10.1590/2175-8239-JBN-2023-0024en","DOIUrl":"10.1590/2175-8239-JBN-2023-0024en","url":null,"abstract":"<p><strong>Introduction: </strong>Management of secondary hyperparathyroidism (SHPT) is a challenging endeavor with several factors contruibuting to treatment failure. Calcimimetic therapy has revolutionized the management of SHPT, leading to changes in indications and appropriate timing of parathyroidectomy (PTX) around the world.</p><p><strong>Methods: </strong>We compared response rates to clinical vs. surgical approaches to SHPT in patients on maintenance dialysis (CKD 5D) and in kidney transplant patients (Ktx). A retrospective analysis of the one-year follow-up findings was carried out. CKD 5D patients were divided into 3 groups according to treatment strategy: parathyroidectomy, clinical management without cinacalcet (named standard - STD) and with cinacalcet (STD + CIN). Ktx patients were divided into 3 groups: PTX, CIN (cinacalcet use), and observation (OBS).</p><p><strong>Results: </strong>In CKD 5D we found a significant parathormone (PTH) decrease in all groups. Despite all groups had a higher PTH at baseline, we identified a more pronounced reduction in the PTX group. Regarding severe SHPT, the difference among groups was evidently wider: 31%, 14% and 80% of STD, STD + CIN, and PTX groups reached adequate PTH levels, respectively (p<0.0001). Concerning the Ktx population, although the difference was not so impressive, a higher rate of success in the PTX group was also observed.</p><p><strong>Conclusion: </strong>PTX still seems to be the best treatment choice for SHPT, especially in patients with prolonged diseases in unresourceful scenarios.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230024"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210536/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138470304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidence of contrast-associated acute kidney injury: a prospective cohort.","authors":"André Lucas Ribeiro, Fabricio Bergelt de Sousa, Beatriz Cavalcanti Juchem, André Zimerman, Guilherme Bernardi, Manoela Astolfi Vivan, Tiago Severo Garcia","doi":"10.1590/2175-8239-JBN-2023-0019en","DOIUrl":"10.1590/2175-8239-JBN-2023-0019en","url":null,"abstract":"<p><strong>Introduction: </strong>Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM.</p><p><strong>Objective: </strong>To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM.</p><p><strong>Methods: </strong>Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses.</p><p><strong>Results: </strong>The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function.</p><p><strong>Conclusion: </strong>The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230019"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210539/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41176154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High volume online hemodiafiltration: a global perspective and the Brazilian experience.","authors":"Maria Eugenia Fernandes Canziani, Jorge Paulo Strogoff-de-Matos, Murilo Guedes, Ana Beatriz Lesqueves Barra, Sinaia Canhada, Luciana Carvalho, Douglas Gemente, Carlos Eduardo Poli-de-Figueiredo, Roberto Pecoits-Filho","doi":"10.1590/2175-8239-JBN-2023-0104en","DOIUrl":"10.1590/2175-8239-JBN-2023-0104en","url":null,"abstract":"<p><p>Online hemodiafiltration (HDF) is a rapidly growing dialysis modality worldwide. In Brazil, the number of patients with private health insurance undergoing HDF has exceeded the number of patients on peritoneal dialysis. The achievement of a high convection volume was associated with better clinical imprand patient - reported outcomes confirming the benefits of HDF. The HDFit trial provided relevant practical information on the implementation of online HDF in dialysis centers in Brazil. This article aims to disseminate technical information to improve the quality and safety of this new dialysis modality.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230104"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138885052","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hemodiafiltration: a synergy yet to be convincing.","authors":"Brammah Rajarajeswaran Thangarajah","doi":"10.1590/2175-8239-JBN-2024-PO02en","DOIUrl":"10.1590/2175-8239-JBN-2024-PO02en","url":null,"abstract":"<p><p>The desperate attempt to improve mortality, morbidity, quality of life and patient-reported outcomes in patients on hemodialysis has led to multiple attempts to improve the different modes, frequencies, and durations of dialysis sessions in the last few decades. Nothing has been more appealing than the combination of diffusion and convection in the form of hemodiafiltration. Despite the concrete evidence of better clearance of middle weight molecules and better hemodynamic stability, tangible evidence to support the universal adoption is still at a distance. Survival benefits seen in selected groups who are likely to tolerate hemodiafiltration with better vascular access and with lower comorbid burden, need to be extended to real life dialysis patients who are older than the population studied and have significantly higher comorbid burden. Technical demands of initiation hemodiafiltration, the associated costs, and the incremental benefits targeted, along with patient-reported outcomes, need to be explored further before recommending hemodiafiltration as the mode of choice.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 2","pages":"e2024PO02"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140287471","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding of the role of serum creatinine in a subset of the Brazilian population.","authors":"Bruno Pellozo Cerqueira, Júlia Ferreira Rocha, Rafaela Francisquetti Barnes, Pedro Henrique Moretti Pepato, Thays Sellan Paim, Francisco De Nardi, Fabrício Akira Hsu, Juliana Miki Oguma, Leticia Miyuki Ito, Enio Yasuhiro Arimatsu Policarpo da Silva, Alexandre Vizzuso-Oliveira, Fernando Diniz Dos Santos Filho, João Vitor Bozza Maia, Juan Diego Zambrano Mendez, Beatrice Borges Sato, Roberto Matias Souza, Andre Kiyoshi Miyahara, Gianna Mastroianni Kirsztajn","doi":"10.1590/2175-8239-JBN-2023-0117en","DOIUrl":"10.1590/2175-8239-JBN-2023-0117en","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease is usually asymptomatic, and its diagnosis depends on laboratory tests, with emphasis on serum creatinine and proteinuria.</p><p><strong>Objective: </strong>To assess knowledge on the role of serum creatinine as a biomarker of kidney function in a sample of the Brazilian population.</p><p><strong>Method: </strong>Cross-sectional observational study conducted in São Paulo (SP, Brazil), in which a random adult population was interviewed.</p><p><strong>Results: </strong>A total of 1138 subjects were interviewed, with a median age of 36 years old (27-52); 55.1% were female. Regarding the \"creatinine\" biomarker, 40.6% stated they had never performed such a test. When asked about their knowledge on the usefulness of this exam, only 19.6% knew its function. The other responses were \"I don't know\" (71.6%), evaluating heart function (0.9%) and liver function (7.8%). Of those who reported they had already taken a creatinine test, only 29.4% correctly identified the role of creatinine. When dividing the groups into \"knows\" and \"does not know\" the function of creatinine, a statistically significant difference (p < 0.05) was observed regarding level of education, female sex, being a healthcare student/worker, having ever measured creatinine, knowing someone with kidney disease and older age. In the multivariate analysis, the main variable related to knowing the creatinine role was having previously taken the test (OR 5.16; 95% CI 3.16-8.43, p < 0.001).</p><p><strong>Conclusion: </strong>There is a significant lack of knowledge about creatinine and its use in checkups. The results indicate that greater efforts are needed from healthcare professionals to raise awareness on the role of serum creatinine.</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":"e20230117"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210534/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139520944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Severe secondary hyperparathyroidism: an increasing problem in CKD but the best management option is still unknown.","authors":"Mark Kung Dah Tiong, Nigel David Toussaint","doi":"10.1590/2175-8239-JBN-2024-E004en","DOIUrl":"10.1590/2175-8239-JBN-2024-E004en","url":null,"abstract":"","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":"46 2","pages":"e2024E004"},"PeriodicalIF":1.3,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11210545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140158162","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sodium-glucose cotranspor ter 2 (SGLT2) inhibitors in nephrolithiasis: should we \"gliflozin\" patients with kidney stone disease?","authors":"Mauricio de Carvalho, Ita Pfeferman Heilberg","doi":"10.1590/2175-8239-JBN-2023-0146en","DOIUrl":"10.1590/2175-8239-JBN-2023-0146en","url":null,"abstract":"<p><p>The prevalence of nephrolithiasis is increasing worldwide. Despite advances in understanding the pathogenesis of lithiasis, few studies have demonstrated that specific clinical interventions reduce the recurrence of nephrolithiasis. The aim of this review is to analyze the current data and potential effects of iSGLT2 in lithogenesis and try to answer the question: Should we also \"gliflozin\" our patients with kidney stone disease?</p>","PeriodicalId":14724,"journal":{"name":"Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2024-02-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139741004","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}